Wednesday, March 5, 2008

The Root of the Mental Health Mess by Scott Mooneyham

RALEIGH -- Gov. Mike Easley might like to wish it away. He might like to claim that he didn't create the mess.

Still, the mental health buck stops at his desk. He's the state's chief executive, meaning that he is ultimately responsible for how state government programs are run.

And a series in The News & Observer of Raleigh starkly lays out how poorly he and his administration have run the program that delivers mental health services to the people of North Carolina.

The articles reveal how millions in tax dollars have been wasted by private companies providing largely bogus services to people who didn't qualify in the first place. Meanwhile, those in real need of psychiatric help and counseling struggle to find anyone in their communities providing legitimate services.

The state Department of Health and Human Services is now trying to recoup $59 million from companies providing a program called community support. These companies billed the state $61 an hour for tasks that included going to movies or to the local Wal-Mart with children. In at least one case, the newspaper detailed how one firm canvassed poor neighborhoods looking to sign up children for "mentoring."

The program, paid for primarily with federal Medicaid dollars, cost $1.4 billion from March 2006 until January 2008. In all likelihood, the waste totals far more than $59 million.

Not surprisingly, Easley points the finger of blame at legislators for beginning this nonsensical reform effort in 2001. No doubt, there is plenty of blame to go around.

Easley officials did warn legislators that they were moving too far and too fast with reforms designed to move mental health treatment away from state institutions to community-based programs.

Nonetheless, if you can get beyond the initial outrage about the program's waste and abuse, some of the fine details -- found both in the newspaper series and elsewhere -- point to where things went wrong.

And many of those decisions were made, not by legislators, but by the Easley administration.

The community support program itself was created by rule-making within agencies overseen by Easley. Top Easley administration officials also made the decision to engage a private company, Norfolk, Va.-based ValueOptions, to oversee "utilization management," a fancy term for deciding who receives services and who doesn't.

That decision, maybe more than any other, is at the root of this mess.

The company, which may do a fine job with billing and other health-related administrative services, essentially rejected no requests for services during the program's first seven months. State rules also allowed initial services for 30 days without a review of whether recipients qualified. Now there's a formula for preventing fraud.

The job should have been left government workers on the ground in North Carolina.

Easley has now put former Raleigh City Manager Dempsey Benton in charge of cleaning up the mess. On way or another, the solution should involve figuring out a way to pull the plug on this fiasco of a program.